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CT imaging of the Eustachian tube using focal contrast medium administration: a feasibility study in humans.

ABSTRACT: Several methods of imaging the Eustachian tube have been tested in the last century, although neither has led to an established method. The introduction of balloon Eustachian tuboplasty (BET) has revived the request for Eustachian tube (ET) visualization in patients with chronic Eustachian tube dysfunction. Many institutions perform preoperative computed tomography (CT) scans of the temporal bone and epipharynx before BET. Purpose We hypothesize that the injection of a contrast medium into the tympanic cavity is safe and feasible and can evolve the CT scan by visualizing the ET lumen and, potentially, the level of obstruction. This study is the initial feasibility study for such a human application. Material and Methods Ten minutes before a CT scan, diluted iodixanol was injected into the middle ear in 18 patients planned for BET due to otitis media with effusion. Five patients with Meniere's disease were controls. Any immediate or delayed adverse events were recorded. Masking of adjacent bony structures in the middle ear on the CT images was evaluated and the most caudally visible contrast medium between the middle ear and epipharynx recorded. Results There were no serious adverse events. One patient reported transitory vertigo. The contrast medium did not mask middle ear structures, apart from the tympanic membrane. The level of contrast medium passage could be assessed. Conclusion Visualizing the ET lumen in humans using intratympanic contrast medium is feasible and safe and does not obscure other valuable image information in a preoperative CT scan.

SUBMITTER: Falkenberg-Jensen B

PROVIDER: S-EPMC6977099 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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CT imaging of the Eustachian tube using focal contrast medium administration: a feasibility study in humans.

Falkenberg-Jensen Benedicte B Jablonski Greg E GE Silvola Juha T JT Kristiansen Joanna F JF Hopp Einar E

Acta radiologica open 20200122 1

Several methods of imaging the Eustachian tube have been tested in the last century, although neither has led to an established method. The introduction of balloon Eustachian tuboplasty (BET) has revived the request for Eustachian tube (ET) visualization in patients with chronic Eustachian tube dysfunction. Many institutions perform preoperative computed tomography (CT) scans of the temporal bone and epipharynx before BET. <b>Purpose</b> We hypothesize that the injection of a contrast medium int ...[more]

PMID: 32030198

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Project description:ObjectiveOne of the main drawbacks associated with Dual Energy Computed Tomography Angiography (DECTA) is the risk of developing contrast medium-induced nephropathy (CIN). The aim of the present study was firstly, to design an optimal CT imaging protocol by determining the feasibility of using a reduced contrast medium volume in peripheral arterial DECTA, and secondly, to compare the results with those obtained from using routine contrast medium volume.MethodsThirty four patients underwent DECTA for the diagnosis of peripheral arterial disease. They were randomly divided into two groups: Group 1 (routine contrast volume group) with n = 17, injection rate 4-5 ml/s, and 1.5 ml/kg of contrast medium, and Group 2 ((low contrast volume group), with n = 17, injection rate 4-5ml/s, and contrast medium volume 0.75 ml/kg. A fast kilovoltage-switching 64-slice CT scanner in the dual-energy mode was employed for the study. A total of 6 datasets of monochromatic images at 50, 55, 60, 65, 70 and 75 keV levels were reconstructed with adaptive statistical iterative reconstruction (ASIR) at 50%. A 4-point scale was the tool for qualitative analysis of results. The two groups were compared and assessed quantitatively for image quality on the basis of signal-to-noise ratio (SNR) and contrast-to-noise-ratio (CNR). Radiation and contrast medium doses were also compared.ResultsThe overall mean CT attenuation and mean noise for all lower extremity body parts was significantly lower for the low volume contrast group (p<0.001), and varied significantly between groups (p = 0.001), body parts (p<0.001) and keVs (p<0.001). The interaction between group body parts was significant with CT attenuation and CNR (p = 0.002 and 0.003 respectively), and marginally significant with SNR (p = 0.047), with minimal changes noticed between the two groups. Group 2 (low contrast volume group) displayed the lowest image noise between 65 and 70 keV, recorded the highest SNR and CNR at 65 keV, and produced significantly lower results with respect to contrast medium volume and duration of contrast injection (p<0.001). The effect of radiation dose was not statistically significant between the two groups.ConclusionsDECTA images created at 65 keV and 50% ASIR with low contrast medium volume protocol, yielded results that were comparable to routine contrast medium volume, with acceptable diagnostic images produced during the evaluation of peripheral arteries.

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CT imaging of the Eustachian tube using focal contrast medium administration: a feasibility study in humans.

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CT imaging of the Eustachian tube using focal contrast medium administration: a feasibility study in humans.

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